In recent years, nothing has helped the skilled nursing sector flex its post-acute care muscles like rehabilitation. Offering short-term rehab stays and outpatient services for discharged acute care patients has opened up a new revenue stream for long-term care facility operators while giving them the opportunity to boost their clinical care operations and forge partnerships with other providers.
The rehab revolution is continuing unabated. More facilities are looking at ways to add it to their portfolio of services while others who have offered it previously are exploring ways to make their programs stronger.
In both instances, facility operators have a lot of questions about the most effective ways of creating a suitable space, utilizing equipment and deploying staff.
Operators new to rehab need to know about how to construct a proper-sized room, what equipment to purchase, which therapies to offer and how to properly staff the operation. Properties undergoing renovation or planning a rehab upgrade want to know what building materials to use, which equipment needs replacing and how to increase the program's marketability.
Focus on function
Specialists from the rehab market have myriad ideas about what skilled nursing facilities should be doing.
While décor and aesthetics play a critical role in attracting prospective residents, their families and referral sources, rehab authorities say the true focus should be functional and not strictly cosmetic.
“Marketing staff and administrators may wish to make the rehab center look more appealing … This is fine as long as therapists are consulted and provided with the most functional tools that offer the best possible results for those who use them,” says Kristy Brown, CEO of Centrex Rehab.
It is easy to get dazzled by a fancy-looking room, but appearance is most superficial, says Mark Besch, vice president of clinical services for Aegis Therapies.
“Rather than focusing on new, shiny equipment, it is more important to ensure the equipment and supplies are adequate and appropriate for patients and that the rehabilitation efforts focus on successful and effective patient intervention,” he says. “Assuming the existing equipment is safe and functional, it is more important how that equipment is used than what it looks like.”
Some facilities have gone so far as to overspend on building materials that ultimately don't matter, says Paul Riccio, vice president of finance and development for Creative Health Solutions.
“I'm surprised how many centers have granite floors but cheap equipment,” he says. “Get regular tile and better equipment. It's your outcomes reputation that matters.”
Sharon Brown, vice president of operations at Synertx, understands the marketing appeal of a distinct rehab center and says simple elegance is an effective showcase.
“Ideally, it should appear distinct from the rest of the facility — a special place of healing and improvement,” she says. “It should have state-of-the-art equipment, but not be too complicated or cluttered. Being able to clearly explain what each piece of equipment does, and how it can improve a patient with a common ailment, is a powerful story that everybody involved in facility marketing should be able to tell.”
To be sure, a freshly renovated rehab unit is an effective marketing tool, adds Christopher Krause, director of the therapy business unit for It's Never 2 Late.
“The best reason to refurbish outdated space is for marketing purposes — people want to go to a place that looks newer, gives the patient and family the impression that the equipment and space is high quality,” he says. “And while it's the actual care that matters whether they will stay, perception matters a great deal when people are deciding on a rehab center.”
Certain pieces of equipment, such as treadmills and stationary bikes, require a considerable cash outlay. In stocking a rehab center with high-end machinery, facility operators have a reasonable expectation of functional performance and durability. Yet questions persist about how and when to replace equipment — especially if the rehab center is set for a makeover.
When to replace
The answer depends on a variety of factors, says Leigh Ann Frick, chief clinical officer for Heritage Healthcare/HealthPRO Rehabilitation.
“If equipment is maintained, cleaned and calibrated regularly, replacements should be few and far between,” she says. “Replacing an entire line if one piece has an issue is not necessary. The key is to replace it with something that looks like it fits in with the other pieces.”
Therapy equipment should have a fairly long life expectancy and replacements should be piecemeal instead of wholesale, Krause says.
“When one piece breaks down, it doesn't mean the whole line of equipment needs to replaced,” he says. “It seems that computers, software and tools for the non-treatment part of the therapists' jobs are the ones that need to be replaced or upgraded most frequently.”
In general, it is the smaller and most-often used items that require consistent replacement, such as light weights and elastic tubing, Besch says.
“Larger items, which also tend to be more costly, have a longer life expectancy,” he observes. “Electro physical agents, such as electrical stimulation units, ultrasound, diathermy and light therapy units, typically will last seven to 10 years, depending on how heavily they are used. Larger weight training equipment often lasts longer than 10 years.”
One vital aspect of equipment assessment concerns safety — for the staff as well as residents, says Laszlo Bayer, vice president of sales and marketing for Therapeutic Industries.
“Clinical advantage of the equipment is important, but it also must provide safety for the clinician who is handling patients eight hours a day,” he says. “It should be designed to prevent the back injuries that come with handling patients, because if a clinician gets injured, that center's ability to provide services diminishes, causing revenue loss. Clinicians should be given the right tools for the job.”
Workers comp claims that might result due to insufficient equipment, can quickly cost more than several pieces of new equipment, experts remind.
Therapies the key
High-end equipment may boost the image of a SNF rehab center, but ultimately, it is the caliber of services that determines its success, rehab specialists say.
“Therapists like equipment, but the key is effective, functional treatments,” Frick says. “Speech language pathologists probably have the biggest challenge with equipment needs as their tests and resources are expensive and each therapist has a personal preference. Sometimes, they bring their own resources to ensure they have what they need.”
Another equipment buying consideration is what items should not be purchased, says Sharon Brown. The wrong equipment, she says, negatively impacts revenues, outcomes and return on investment.
“You need to work collaboratively with both your rehab vendor and onsite therapists to ensure the equipment you buy will be regularly utilized and meet your goals. We've found that the equipment being pushed by vendors isn't always the equipment that gets used most often.”
Selecting the right equipment also increases the chances of retaining top therapists, notes Brown, because they tend to leave the jobs requiring them to use tools they don't like.
“When you ask therapists about the equipment they need to do a better job, they typically say they don't want fancy equipment or the hottest item on the market,” she says. “Instead, they want workable equipment that will lead to a more safe delivery of services.”
Overall, operators are still searching for their optimal role in the delivery of care across the post-acute care continuum and evaluating how services should be provided in the proper setting, Aegis's Besch believes.
“Rehabilitation efforts are a significant component of post-acute care and despite the changing landscape, I believe that it is widely recognized that rehabilitation has value to patients, caregivers and payers,” he says. “Given the important role that rehabilitation plays, I believe providers are committed to ensuring adequate staff and resources to meet patient care needs.”
An evolving rehab segment is not only having a positive impact on the long-term care industry, it is also benefitting the healthcare industry as a whole, says Riccio.
“This trend is most evident in the federal budget report, which shows that rehab has had the least cost impact while providing the greatest return,” he said. “When you look at the $60 billion Medicare has spent on acute care compared to $30 billion on post-acute rehab, you can see that is where the market is going.”
For SNFs, the advantages of having a solid rehab program are threefold, Riccio says: It can be the deciding factor in an increasingly competitive field; it appeals to boomers and discriminating seniors; and it gives facilities an edge with hospitals for ACO alliances.